Relative value of the lumbar spine and hip bone mineral density and bone turnover markers in men with ankylosing spondylitis

Abstract

The purpose of this study is to evaluate bone mineral density (BMD) and bone turnover markers in men with ankylosing spondylitis (AS) and to determine their relationship with clinical features and disease activity. Serum carboxi terminal cross-linked telopeptide of type I collagen (CTX), osteocalcin (OC) levels, and BMD of lumbar spine and proximal femur were evaluated in 44 males with AS, 18-60 years of age, and compared with those of 39 age-matched healthy men. Men with AS had a significantly lower BMD at the femoral neck and total hip as compared to age-matched controls (all p < 0.01). Osteopaenia or osteoporosis was found in 59.5% AS patients at the lumbar spine and in 47.7% at the femoral neck. Mean serum levels of OC and CTX were similar in AS patients and controls. There were no significant differences in BMD and bone turnover markers when comparing subgroups stratified according to disease duration or presence of peripheral arthritis. No correlations were found between disease activity markers and BMD or OC and CTX. In a cohort of relatively young males with AS, we found a high incidence of osteopaenia and osteoporosis. Disease activity and duration did not show any significant influence on BMD or serum levels of OC and CTX.

Bone Mineral Density Changes in Patients with Spondyloarthropathies

“…Furthermore, the role of proinflammatory cytokines might be important for the onset of osteoporosis because increased TNF-alpha levels have been found in patients with AS compared with subjects with noninflammatory back pain, and correlations have been found between disease activity and markers associated with an increased bone metabolism (Lange et al, 2000). We, together with other authors think that cross-sectional laboratory acute inflammatory markers such as CRP or ESR and results of BASDAI questionnaire which reflects the main SpA symptoms during the last week can not predict BMD changes (Karberg, 2005;Speden, 2002;Muntean, 2011). Only a physician rheumatologist's assessment of the entire case history including clinical, laboratory, radiological signs and taking regular care of the patient may accurately determine disease activity in the long course of disease activity.…”

“…Agreeing with other authors (Donnelly, 1994;Reid, 1986;Mullaji, 1994), we think that vertebral BMD readings of patients with long disease duration measured by anteriorposterior view of DXA method are merely "deceptive". The lumbar spine often shows misleading high BMD values due to bridging syndesmophytes and ankylosis, which might mask osteoporosis in AS patients with an advanced disease (Donnelly, 1994;Karberg, 2005;Mullaji, 1994;Muntean, 2011).…”

“…Other authors have made similar conclusions to proving that acute inflammatory phase markers found once do not forecast either progression of radiological signs of SpA or reduction of BMD in different parts of skeleton. (Karberg, 2005;Toussirot, 2001;Muntean, 2011). Nevertheless, J. Gratacos and colleagues having carried out a two year perspective study and assessing AS disease activity by ESR, CRP and IL-6 blood concentration found that the subgroup of active disease patients had statistically significant reduction of BMD of femoral neck and lumbar spine but there were no significant BMD changes in the examined parts of the subgroup of non-active disease patients.…”

Alteration of Bone Turnover Markers in Canonical Wingless Pathway in Patients With Ankylosing Spondylitis

“…As well known bone turnover markers, OC [26][27][28][29][30][31][32][33][34][35][36][37][38] (supplemental data 2) and ALP 29,32,36,[39][40][41] (supplemental data 3) have been frequently assessed in AS in former studies; however, to our knowledge, they have not yet been evaluated in parallel with other markers in the Wnt signaling pathway. OC expression was similar between AS patients and controls.…”

Alta Densidade Mineral Óssea: Dentro Da Normalidade Ou Mascarando a Fragilidade Óssea?

“…Outras alterações associadas a alta DMO são hiperostose idiopática difusa 20 , fraturas vertebrais 21 , espondilite anquilosante 22 , calcificação de estruturas intra-abdominais como o aorta 17 , depósitos de ferro em pacientes com talassemia maior 23 , cálculos renais 24 e implantes de silicone na região glútea 25 . Alterações significativas na medida da DMO podem ser causadas por anormalidades focais, como doença de Paget 16 e alguns tumores 26 .…”